Kern Family Health Care · 22 hours ago
Clinical Intake Coordinator RN I
KHS Buck Owens Office, 2900 Buck Owens Blvd., Bakersfield, California, United States of America
Full-time
Onsite
Entry, Mid Level
$40.20/hr - $51.26/hr
2+ years expKern Health Systems is dedicated to improving the health status of its members through an integrated managed health care delivery system. The RN Clinical Intake Coordinator is responsible for supporting clinical Utilization Management activities, conducting medical necessity reviews and facilitating decision-making based on established guidelines.
Health CareHospitalNon Profit
Responsibilities
Performs review of requested outpatient and elective, prospective inpatient medical services
Under the direction of the UM Outpatient Clinical Supervisor coordinates and refers KHS members for services which are carved out of KHS medical coverage
Assists in the authorization and processing of automatic referral requests
Responsible for written and verbal communication with contract providers and internal KHS staff to promote timely coordination of care and dissemination of KHS policies and procedures
Collaborates with the KHS Member Service Department and the Provider Relations Department regarding quality of care and other grievance issues to facilitate timely problem resolutions
Utilizes clinical guidelines as well as Medi-Cal criteria to review DME, home care, and outpatient service requests for medical necessity and benefit coverage while processing referral request
Identifies and refers cases for quality of care, coordination of benefits, and third-party liability issues as appropriate
Maintains knowledge of covered benefits for all programs
Identifies and refers cases appropriate for various internal programs. Shares information as necessary with appropriate Population Health Management team: Case Management, Transitions of Care, Major Organ Transplant and Community Support Services including but not limited to Enhanced Care Management
Identifies authorization issues and brings those requiring attention to the UM Outpatient Clinical Supervisor
Reviews requests for non-par services and coordinates these with input from the Medical Director based on par provider availability in the member’s geographic area
Selects, formats, proofreads and prints appropriate member and provider denial letters prior to mailing
Determines medical appropriateness and necessity of care using established criteria within mandated turnaround times
Appropriately refers cases that do not meet medical necessity to the Medical Director
Keeps current with California Children’s Services benefits and guidelines for coordination of services
Other duties as determined based on Department needs
Qualification
Required
Registered Nurse (RN) with an active, current, unrestricted CA license
Minimum of two years (2) full-time clinical experience in acute care, community health setting, public health nursing or chronic disease management required
Preferred
Bachelor's Degree from an accredited school or equivalent in Nursing, Health Administration or related healthcare field preferred
Understanding of utilization management principles preferred
Experience with MCG Health LLC clinical guidelines and Medi-CAL coverage preferred
Experience working in case management or care coordination is a plus
Knowledge of Kern County Community resources for seniors and people with disabilities is a plus
Bilingual (English/Spanish) preferred
Company
Kern Family Health Care
Kern Health Systems, known as Kern Family Health Care, was established in 1993 as a managed care health plan, and is the largest health plan in Kern County.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Emily Duran
Chief Executive Officer
Alan Avery
Chief Operating Officer
Recent News
2025-01-07
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